Symptomatic Epilepsy: What Is It, Causes, Symptoms, Treatment

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Symptomatic epilepsy

The content of the article:

The reasons
Classification
Symptoms
Diagnostics
Treatment
Course and forecast
Pregnancy and lactation
Video

Symptomatic epilepsy is a chronic neurological disorder characterized by repeated seizures caused by excessive electrical activity in a specific group of neurons (nerve cells) in the brain. This activity is always associated with the presence of one or another cerebral pathology in the patient. In the general structure of the incidence of epilepsy, the symptomatic form accounts for 25% of cases.

Symptomatic epilepsy develops as a symptom of the underlying disease

The reasons

Symptomatic epilepsy (SE, episyndrome) always develops secondarily, as a complication of any pathology. The main reasons leading to its occurrence are:

metabolic disorders (phenylketonuria, hypoparathyroidism, hypoglycemia);
cerebrovascular diseases (strokes, vascular malformation, vasculitis);
volumetric processes (tumors, hematomas, parasitic cysts, brain abscess);
congenital anomalies of the brain;
traumatic brain injury, including birth;
cerebral hypoxia (asphyxia of newborns, carbon monoxide poisoning, Adams-Stokes syndrome);
central nervous system infections (brain cystercosis, toxoplasmosis, malignant malaria, HIV infection, tetanus, rabies, neurosyphilis, encephalitis, meningitis);
poisoning with toxic agents and drugs (cocaine, alcohol, lead, picrotoxin, strychnine, corazole, camphor);
anaphylactic reactions;
edema of the brain (eclampsia, hypertensive encephalopathy);
withdrawal symptoms after prolonged use of alcohol, tranquilizers, anticonvulsants;
hyperpyrexia (heatstroke, acute infections).

Classification

Depending on the characteristics of the clinical manifestations, seizures in epilepsy are divided into several types:

Seizure type	Description
Simple partial (local, focal)	Consciousness is preserved. The attack can proceed: · With vegetative characteristics; · With sensory specific and somatosensory symptoms (hallucinosis); · With movement disorders; With mental symptoms (affective, cognitive, dysmnesic, dysphasic). In some cases, an attack with this form of the disease begins as a simple one, and then, a wave of pathological excitement begins to spread throughout the cortex of both hemispheres, that is, the process is generalized, which leads to the appearance of classic tonic-clonic seizures (secondary generalized seizure).
Complex partial	In most cases, the attack begins as a simple one, after which the patient develops a disturbance of consciousness. Sometimes only loss of consciousness is observed.
Absances (minor epileptic seizure, petit mal)	The seizure can proceed: · With a vegetative component; · With automatisms; · With a tonic component; · With an atonic component; · With a clonic component; · Only with impaired consciousness.
Myoclonic	Sudden twitching of certain muscle groups or muscles of the whole body.
Tonic-clonic (large seizure, grand mal)	It appears suddenly. The patient lets out a loud scream and collapses, losing consciousness. The clonic phase lasts 10-30 seconds, then it is replaced by clonic convulsions lasting 1-3 minutes.
Febrile	They are observed in children under the age of five against the background of a high rise in body temperature. At the same time, it is not possible to explain the development of generalized seizures by the presence of any other reasons.
Status epilepticus	This condition is one of the most severe forms of symptomatic epilepsy. The seizures follow continuously one after the other and in the intervals between them the patient's consciousness is not restored.

Symptoms

Consider the main clinical manifestations of various types of epileptic seizures:

Seizure type	Symptoms
Absances	The seizure occurs in the form of a short-term loss of consciousness with minimally expressed motor activity. Lasts 10-30 seconds. The person suddenly stops his activity and, after the end of the attack, resumes it. Seizures usually occur during physical activity and are almost never seen during rest.
Tonic-clonic seizure	The onset of a seizure is preceded by a short-term aura. Following her, the patient screams, loses consciousness and falls. He has respiratory arrest, cyanosis of the facial skin. Tonic convulsions last 10-40 seconds and are replaced by clonic ones. There is a noisy breath, foam appears from the mouth, cramps of all muscle groups are noted. The total duration of the seizure is 2–5 minutes.
Myoclonic seizure	More often observed with encephalitis, degenerative diseases and metabolic disorders. It is characterized by sudden twitching of the muscles in the trunk or limbs.
Simple partial seizure	It is manifested by isolated clonic or tonic activity, transient sensory disturbances. There are no impairments of consciousness.
Complex psychomotor (partial) seizure	Its development is often preceded by an aura. The patient loses contact with others for 1–2 minutes. At this time, he makes useless automatic movements, does not understand the speech addressed to him, can make inarticulate sounds.
Febrile seizures	Occur in children under the age of five with a fever. There are two types: · Benign - generalized, single short; · Complicated - occurring more than twice during the day or focal, lasting more than 15 minutes.
Status epilepticus	Mental, sensory or motor seizures go on almost without interruption and last from several hours to several days. In the absence of timely medical care, there is a high probability of death.

With a prolonged course of symptomatic epilepsy, patients gradually develop chronic personality disorders, which include the following symptoms:

excessive sentimentality;
excessive pedantry;
rancor;
suspicion;
cruelty;
vindictiveness;
outbursts of anger.

The patients' speech becomes stereotyped, slowed down, and detailed. They can hardly switch from one topic of conversation to another.

With the malignant course of the disease, dementia develops. The patient experiences the following changes:

decreased intelligence;
selective memory impairment (they remember well only what is important to him);
limiting the range of interests solely to their needs;
aggressiveness, cruelty;
disinhibition of instincts;
ridiculous behavior;
lack of criticism.

Diagnostics

The main diagnostic method for symptomatic epilepsy is electroencephalography (EEG). If necessary, the patient is recommended to perform EEG monitoring (night, daily).

In order to establish the root cause of the disease, a laboratory and instrumental examination of the patient is shown, which, according to indications, may include the following methods:

CT and MRI of the brain - allow you to visualize possible focal lesions of the cerebral tissue;
general blood test - with a neuroinfectious process, there is an increase in the number of leukocytes, a shift in the leukocyte formula to the left;
biochemical blood test, including the determination of the concentration in plasma of electrolytes, glucose, urea;
toxicological blood test for alcohol content, medicines.

Differential diagnosis is carried out with a number of diseases and pathological conditions:

dementia;
schizophrenia (with epipsychoses);
trigeminal neuralgia;
simulation of an epileptic seizure;
fainting;
migraine;
narcolepsy.

Treatment

Symptomatic epilepsy is treated on an outpatient basis. Patients with status epilepticus are subject to emergency hospitalization in the intensive care unit.

Anticonvulsant therapy is used to treat epilepsy

Conservative therapy of the disease consists in long-term regular intake of anticonvulsants (anticonvulsants). In case of ineffectiveness, the possibility of surgical treatment is considered (dissection of the corpus callosum, excision of the epileptic cortical focus, resection of the temporal lobe).

The main treatment for febrile seizures is to lower body temperature. The child is prescribed non-steroidal anti-inflammatory drugs, antispasmodics, physical cooling is performed. With repeated febrile seizures, prophylactic administration of diazepam is justified. The drug is used during the entire period of fever and 24 hours after the temperature has returned to normal.

Course and forecast

Symptomatic epilepsy is more difficult to treat than idiopathic epilepsy. Patients often develop mental disorders, and the frequency of their occurrence does not depend on the frequency of attacks.

If, against the background of anticonvulsant therapy, the patient does not have epileptic seizures for two years, then drug treatment is gradually canceled. However, a third of patients subsequently relapse.

Pregnancy and lactation

Against the background of taking anticonvulsants by a pregnant woman, the risk of congenital anomalies in the fetus increases 2 times. Therefore, pregnant women, especially in the first trimester, are advised to reduce the dosage of anticonvulsants. But if they develop an epileptic seizure, then they should definitely return to the original dose.

In order to reduce the risk of fetal anomalies, folic acid intake is indicated throughout the entire period of pregnancy (it is advisable to start at the planning stage).

When the mother is taking anticonvulsants, breastfeeding is not contraindicated, but the concentration of drugs in breast milk should be checked regularly.